Outcomes of Severely Comminuted (Type III) Nasoorbitoethmoid FracturesAlan S. Herford, DDS, MD, Thomas Ying, DDS†, Brandon Brown, DDS‡Abstract Purpose Nasoorbitoethmoid (NOE) fractures are complex and often challenging to repair. Inadequate treatment may result in secondary deformities which are difficult to treat. Severely comminuted fractures require repositioning of the medial canthal tendon. The purpose of this study was to evaluate all results in treating these challenging injuries. The work is to be used as a basis for continuing quality improvement of our surgical technique. Patents and Methods Ten consecutive patients who sustained a comminuted NOE (type III) fracture were included in this study. All patients had comminution of the central fragment involving the detachment of the medial canthus. Results Transnasal reduction, primary grafting, and plate and screw fixation were used for all patients. Two patients demonstrated slight asymmetry between the medial canthi. Two patients were observed to have overprojection in the nasofrontal region. Conclusion Severely comminuted type III NOE fractures are best treated primarily to avoid secondary deformities.

Early repair of avulsive facial wounds secondary to trauma using interpolation flaps Alan S Herford, DDS, MDAbstract Purpose This article describes the use of various local interpolation flaps for the reconstruction of facial defects resulting from trauma. Patients and methods Fifteen interpolation flaps were used to restore missing tissue of 14 patients who sustained trauma. Two of the procedures were performed as a single stage, whereas 13 flaps required a separate surgery to “take down” the pedicle. All flap procedures were performed within 72 hours from the time of trauma. Four types of interpolation flaps were used. Results All flaps healed without evidence of infection, dehiscence, or necrosis. Two patients required secondary treatment 6 months after the flap procedure. Conclusion Various local interpolation flaps provide a reliable and aesthetic treatment option for early repair of soft tissue defects secondary to trauma.